TECHNOLOGY AS A CATALYST FOR SUPPORTING AGING WITH DISABILITY

Abstract Individuals aging with long-term disabilities may need support to perform and participate in everyday activities associated with well-being and quality of life. Technology solutions have potential to effectively promote autonomy and aging-in-place for this population. This symposium will highlight technology research and development efforts from the Rehabilitation Engineering Research Center on Technologies to Support Aging-in-Place for People with Long-Term Disabilities (RERC TechSAge). TechSAge is dedicated to understanding the needs of, and developing supportive technologies for people aging with long-term vision, hearing, and mobility disabilities. Mumma et al. will present insights from interviews of adults aging with vision loss due to glaucoma and macular degeneration regarding their challenges and response strategies for everyday activities. Lee et al. will discuss findings from interview data exploring how wisdom is manifested from the lived experiences of individuals aging with disability (i.e., hearing, vision, and mobility). Mitzner et al. will describe characteristics of the participant sample from a clinical trial examining the effect of a Tele Tai Chi intervention on physical activity and social connectedness for adults aging with long-term mobility disabilities. Sanford et al. will present the findings from three TechSAge pilot projects focused on the use of technology to support in-home rehabilitation for individuals aging with long-term upper extremity disabilities: DigiHand, KeyStroke, and 3DP for AT. Together these studies illustrate the needs and coping strategies of older adults with disabilities and the potential of technology to support those needs. This is a collaborative symposium between the Lifelong Disabilities and Technology and Aging Interest Groups.

United States,4. Harvard Medical School,Boston,Massachusetts,United States Nursing homes face rapidly increasing wages and change their input mix as they face workforce shortfalls.For 15,959 freestanding NHs from 2017-2021, the proportion of hours worked by agency staff and the median wage cost per hour of agency and directly employed nursing staff were calculated from Medicare cost reports and Payroll-Based Journal data.The median hourly wage cost of directly employed staff (wage and fringe) increased 18.1% for RNs (to $41.99 in 2021), 19.8% for LPNs ($32.29), and 27.5% for CNAs ($19.62).The median hourly wage cost of agency staff (amount paid to staffing agency) increased at a faster rate and was substantially higher: 22.8% for RNs ($64.19);28.3% for LPNs ($52.42), and 34.9% for CNAs ($33.73).The use of agency staff increased, starting from approximately 2% of all nursing staff hours for each of the nursing staff types in Q1 2017 to 5.6% hours for RNs, 9.4% hours for LPNs, and 8.8% hours for CNAs in Q4 2021.These observations have implications for quality and access to nursing home care.High use of agency staff may affect quality of nursing home care, and substantial wage differences between agency and directly-employed staff may affect worker satisfaction and attachment of directly employed workers.Hourly wage costs for all nursing staff have increased more rapidly than nursing home revenues, which only increased 16.6% over the study period; this suggests that, without payment rate increases, nursing homes may reduce labor inputs to contain costs, or may go out of business.

THE EFFECT OF GERMANY'S LONG-TERM CARE STRENGTHENING ACT II ON NURSING HOME USE
Freya Diederich, University of Bremen, Bremen, Bremen, Germany In Germany, out-of-pocket costs for nursing home care have substantially increased during the last years.There is an ongoing discussion whether these out-of-pocket costs should be capped.However, a decrease in costs may increase nursing home use and the social costs of nursing home care.This study analyzes how a change in out-ofpocket costs for nursing home care affects nursing home use.We use discontinuities in out-of-pocket costs that arose from Germany's Long-Term Care Strengthening Act II in 2017.The Long-Term Care Strengthening Act II decreased average nursing home care costs for people with higher care needs and increased average costs for people with lower care needs.Long-term care insurance data are analyzed using a regression discontinuity design.There is no significant change in nursing home use among people who enter long-term care with relatively high care needs.However, there is a significant decrease in nursing home use among those who enter long-term care with relatively low care needs.The results are robust regarding different specifications of the model.We conclude that the elasticity of nursing home use depends on the level of care needs.For people with high care needs, nursing home care is often without alternatives, whereas people with lower care needs may substitute nursing home care with informal care.A generous public policy does not necessarily increase demand for nursing home care.
Abstract citation ID: igad104.0124 1) relationships between geographic context and healthcare costs (hospitalization, medical, outpatient, prescription, dental); and 2) whether dementia status moderates the geographic context-healthcare costs relationship.We hypothesized that persons with dementia incurred higher healthcare costs in both countries, and that residents in less populated areas had lower healthcare costs than their counterparts.We used multivariable logistic regressions and generalized linear models, accounting for personal, healthcare access, and utilization factors.Results suggest that in 2012 (MHAS n = 15,723), persons with dementia in México had average healthcare costs that were 60.3% greater compared to those without dementia.Individuals with dementia also had a higher probability (11.9% p = 0.040) of incurring any healthcare costs in less densely populated areas (under 15,000 persons).In contrast, Hispanics participating in the HRS during that period (n=15,567), 58% of whom were of Mexican origin, did not have higher total healthcare costs if diagnosed with dementia, but incurred larger expenses in rural areas compared to their urban counterparts (p< 0.001).These results underscore how geographical context varies across countries and how dementia status can leave some individuals more financially vulnerable than others, affecting their access to healthcare services and overall health.

TECHNOLOGY AS A CATALYST FOR SUPPORTING AGING WITH DISABILITY Chair: Tracy Mitzner
Individuals aging with long-term disabilities may need support to perform and participate in everyday activities associated with well-being and quality of life.Technology solutions have potential to effectively promote autonomy and aging-in-place for this population.This symposium will highlight technology research and development efforts from the Rehabilitation Engineering Research Center on Technologies to Support Aging-in-Place for People with Long-Term Disabilities (RERC TechSAge).TechSAge is dedicated to understanding the needs of, and developing supportive technologies for people aging with long-term vision, hearing, and mobility disabilities.Mumma et al. will present insights from interviews of adults aging with vision loss due to glaucoma and macular degeneration regarding their challenges and response strategies for everyday activities.Lee et al. will discuss findings from interview data exploring how wisdom is manifested from the lived experiences of individuals aging with disability (i.e., hearing, vision, and mobility).Mitzner et al. will describe characteristics of the participant sample from a clinical trial examining the effect of a Tele Tai Chi intervention on physical activity and social connectedness for adults aging with long-term mobility disabilities.Sanford et al. will present the findings from three TechSAge pilot projects focused on the use of technology to support in-home rehabilitation for individuals aging of vision loss may cause different problems.For example, macular degeneration leads to a loss of foveal vision whereas glaucoma leads to peripheral vision loss.As part of the Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) study, we are using a mixed-methods approach to explore the unmet needs of older adults with these two conditions to provide guidance for interventions.We will present insights from 51 older adults (mean age = 69, SD = 5.5) who have had serious difficulty seeing for an average of 42 years (SD = 24.3)due to either glaucoma (n = 28), macular degeneration (n= 19), or both conditions (n = 4).We will present participants' difficulty ratings for a wide range of everyday activities as well as initial themes and illustrative quotes from interview data on challenges and response strategies for their most difficult activities (e.g., shopping, traveling for leisure, dressing).For example, it can be difficult to navigate through a crowded store and read details on labels when shopping.Additionally, flying was described as frustrating and stressful because airports can be unfamiliar and require arrangements (e.g., transportation to/from, guidance to the gate).Moreover, when getting dressed, participants said that they rely on touch to differentiate between clothes; however, color coordination and matching can be very difficult.Data provide insights on unmet needs among people aging with vision loss and illuminate opportunities for technology innovation.Wisdom can benefit one's well-being and lead to a more fulfilling life.One pathway is using wisdom as a resource for coping with adversities in life.At the same time, wisdom can be fostered from experiencing adversities in life.The TechSAge ACCESS interview study explored the challenges and coping strategies of individuals aging with disability (i.e., hearing, vision, and mobility), providing us the opportunity to investigate the wisdom fostered from participants' lived experiences.Studying wisdom in a population with disability has at least two practical implications for the intersectional field of aging, disability, and technology.First, we can gain and disseminate the knowledge regarding how to cope with aging with disability, which would benefit individuals with similar disability and their care networks.Second, we can utilize participants' wisdom to guide our research.Focusing on their strengths and coping strategies instead of their weaknesses would offer us additional ways to support individuals aging with disability.There are specific merits to utilizing the ACCESS data for wisdom research.The sample of individuals aging with disability allows us to explore wisdom that manifested as an interaction between a person and a situation.We are exploring participants' answer to the question regarding the advice they would give to others with similar disability as a wisdom assessment task.This is a contribution to the wisdom literature as it is rare to be able to administer assessment tasks that are relevant to participants' lives and interests.
Mónika López Anuarbe 1 , and Angela Gutierrez 2 , 1. Connecticut College, New London, Connecticut, United States, 2. Ohio University, Athens, Ohio, United States Dementia prevalence and costs affect subpopulations differently, generating healthcare and aging disparities.Most research on healthcare costs associated with dementia has overlooked cross-national comparisons among Hispanics in general and Mexicans in particular.This study utilizes the 2012-2018 Mexican Health and Aging Study (MHAS) and Health and Retirement Study (HRS) to assess: